This week I watched Louis Theroux’s BBC documentary on severe alcoholism. The programme followed patients of King’s College Hospital as they were admitted to A&E or to detox programmes, and spoke to specialists trying to deal with the many health problems from which they suffered. It was difficult viewing.
One scene called out for future use in clinical training as an example of ‘breaking bad news’ and how not to do it! A middle-aged man, Stuart, attended a clinic with his wife to discuss his current health. He said he knew he was seriously ill. He knew from talking to other patients that things did not look good. The doctor started to give some information. ‘You have a score of 22. If we had a whole group of people with a score of 22, 76% of that group wouldn’t last three months with that score.’ The camera moved to Stuart’s face. This looked like new information that he was struggling to process.
That wasn’t the hardest part to watch. As other reviewers have commented, the story of Aurelia was particularly compelling. Aurelia was a middle-aged woman who had spent her early years in children’s home in France but now lived in London. Her boyfriend was abusive and undermining, but she thought he was the best she could hope for. Aurelia expected and perhaps wanted to die. For her, talk about her limited life expectancy was not shocking. A doctor tried to talk to her about her health but the conversation was quite different from the one with Stuart.
Specialist: Your health is deteriorating… Your liver is the most forgiving of your organs if you treat it well…
Aurelia: I eat vegetables…
Specialist: I’m struggling to see a way forward…
Aurelia: So do I.
Specialist: Most of the strategies… it’s old news… you’re not responding to it, have you gone beyond caring or…
Aurelia: Beyond hearing. I’m surprised I’m still alive.
Aurelia’s flash of humour reminding the specialist of things she did do to preserve her health reminds us of all the myriad responsibilities that we are now encouraged to shoulder. She was meant not only to eat her vegetables but also to look after her liver, and respond appropriately to news about her illness. She was meant to want to live.
This section of the programme reminded me powerfully of sociological writing about biological citizenship. The concept highlights the ways in which our relationships with our governments, our political lives, may be increasingly oriented around bodily experiences and health. It has been used to emphasise the importance of ‘staying healthy’ in order to appear a good citizen, as well as engaging with health information in different forms.
In the programme Theroux and medical staff grappled with exactly how far this requirement should be taken. Though Theroux said he stopped judging the patients as people who made bad choices in the past, he continued to be troubled about how far to step into the situation now, for example with Joe, who was in and out of A&E and detox. This was phrased as a question of responsibility.
Doctor: Whose responsibility is it to care for him? Family? Friends? Us? Him? It’s tricky.
Theroux: When you’re around him you get sucked into this vortex of wanting to help but also not wanting to mother him.
Doctor: He’s looking for support and to be looked after.
The doctor there seemed more ready than Theroux to talk positively about care. But did that mean they should stop him when he left the hospital looking for vodka? Should they call the police?
Different people will respond differently to Theroux’s style, but he certainly was able to engage with his subjects and their ethical and emotional struggles. In one scene Aurelia asked him directly, ‘How does it make you feel when you see people like me?’ His answer, ‘I think you deserve a better life.’ Theroux’s comment seemed to come from the heart but it also showed that like ‘responsibility’ the idea of ‘deserving’ something is surprisingly sticky. Theroux tried to probe how Joe deserved support from family and friends, the doctors struggled with the best way to offer care and information to their patients.
What was absent from those patients and from others seemed a sense of the state and its responsibility. The other side of biological citizenship in the sociological literature is an opportunity to make claims for health services: indeed, the concept was developed by Adriana Petryna writing about the health claims made by victims of the Chernobyl disaster, which had its anniversary last week.
But the language of rights rather than ‘deserts’ was somehow absent in this documentary. ‘I think you deserve better’ was a plea for Aurelia to believe that she could claim a better life for herself. She definitely didn’t believe it. The problem I have with an otherwise fascinating programme came down to its politics. Alcoholism was presented as an appalling personal tragedy, stemming from emotional and mental troubles as well as physical addiction. In this is seemed to have much in common with the Channel 5 documentary on the same subject, reviewed here in January. But where was the ‘social’ explanation and the collective solution? Where were rights?
‘Drinking to Oblivion’ was first broadcast on BBC 2 on the 24 of April and is available on the BBC iPlayer until 14 of May 2016